In a letter to Prime Minister Narendra Modi ahead of World TB Day, which is observed on March 24, activists, public health experts, tuberculosis survivors, and people living with HIV sought his urgent intervention to halt what they said were frequent shortages of anti-TB drugs.
The letter highlighted the shortage of drugs essential for treating drug-sensitive TB (DS-TB). “As a country with the highest burden of tuberculosis in the world, we are deeply disturbed that India is experiencing stock outs of critically required drugs to treat people with TB,” the group said, in its letter.
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“Till February 2024, [these] drugs — 4FDC-1 st line DSTB-IP(Adult) Isoniazid, Refampicin, Pyrazinamide and Ethambutol, 3FDC-1 st line DSTB-CP(Adult) Isoniazid, Refampicin, and Ethambutol — are facing shortages. This is as per the limited information received from the community/TB people in the affected areas and records only a fraction of the actual shortages and stock-outs that have occurred,” they added.
‘Shortages spur drug resistance’
The National TB Elimination Programme (NTEP) acknowledges that an uninterrupted supply of quality assured anti-TB drugs is an essential component of it DOTS strategy, the group said, pointing out that an inadequate and poorly administered treatment regimen facilitates drug-resistant strains of the disease.
The most severe impact of these persistent stockouts of anti-TB drugs is on people currently on treatment, leading to a situation of treatment interruption and a very high risk of developing resistance. This also affects treatment outcomes, increasing the risk of the disease in the community, and thereby putting an additional burden on the TB programme, the group warned.
Affecting livelihoods
They added that the unavailability of required drugs for treatment forces people to visit the centres multiple times, often skipping work and foregoing their wages, making them choose between their livelihood and treatment, thereby affecting their adherence to the treatment.
“We would also like to highlight that TB patients may be asked to procure these drugs out of pocket. However, TB patients may not receive the appropriate fixed-dose combinations or may be too poor to procure them. The TB programme has sent a letter/memorandum to the State TB officers to initiate procurement at the district level. However, the communication was considerably delayed and was sent on 18 March 2024 even as the shortages had started,” the letter noted.
Stating that decentralised procurement of this kind is especially challenging for States limiting their power to negotiate on quantity, price, and delivery timelines, the group added that limited budgets may also result in States procuring drugs that are not quality-assured, and may not be the appropriate fixed dose combinations, thereby compromising people’s treatment outcomes.
‘False’ reports last year
This is not the first time that there have been complaints of drug shortages; in fact, complaints came in late last year as well.
The Health Ministry had then maintained that all media reports claiming shortages of anti-TB medicines were false, motivated, and misleading. It added that all anti-TB drugs in the country were available, with sufficient stock for a time period ranging to six months and above. “Centre proactively undertakes regular assessments to evaluate the stock positions at various levels, from central warehouses to peripheral health institutes,” it had said.
